Fill and Sign the Application for Tuition Refund Form

Application for Tuition Refund Name: ________________________ Date of Hire: ___________________________ Department: ____________________ Job Title: ______________________________ I request approval to enroll in the following course: ________________________________ _________________________________________________________________________ Course Title: _______________________ Institution: _____________________________ Semester and Year: _________________ Tuition Cost: ___________________________ Reason for taking course: ___________________________________________________ Degree/certification working towards, if any: ____________________________ 1. Tuition will be paid at 100% upon receipt of fee statements and grades of “B” or better or “Pass” if the course is taken on pass/fail basis. Books and miscellaneous lab or activity fees are not covered under the Tuition Reimbursement Program. 2. All expenses must be validated by receipts and a copy of the final grade card or certification must be presented to show hours or certification received. 3. Reimbursement requests must be submitted to the Director of Human Resources within 30 days of passing grade/certification. 4. Scheduling/attendance of class time must not impede work duties and responsibilities or affect the performance of the individual or work team. The employee shall be held accountable for his/her regular workload and assignments. 5. The employee must still be remain employed by __________________________ (Name of Employer) for a minimum of one year from the time of course completion. 6. The course must be pre-approved by the Human Resources Director and District Administrator. I have read, understand and agree to comply with the provisions relating to the Employee Tuition Reimbursement Program. _______________________________ Date: _________________ (Printed Name of Employee) _______________________________ (Signature of Employee) Proof of registration and tuition payment will be required before reimbursement can be approved. Please attach if available. Department Director Approval:_____________________________ Date: ____________ Human Resources Approval: _________________________________ Date: ____________ District Administrator Approval: ____________________________________ For Human Resources Use Only: Grade Attained: _____________ Date of Approval: _____________ Eligible for $______________________ Submitted to Finance [ ] Issue Check to ____________________________________________ Education/Tuition Reimbursement Policy Purpose _______________________ (Name of Employer) supports employees who wish to continue their education to secure increased responsibility and growth within their professional careers. In keeping with this philosophy, ___________________________ (Name of Employer) has established a reimbursement program for tuition expenses incurred through approved institutions of learning. Eligibility  The employee must be a regular, full-time employee for one full calendar year.  The employee must have had no disciplinary actions within 6 months prior to date of request for reimbursement. Pre-Qualification Criteria  The course must be pre-approved by the Employee’s Department Director, the Human Resources Director and the Employee’s District Administrator.  The District Administrator my grant a waiver of certain obligations at his/her discretion.  The Department Director should include the tuition reimbursement funding with their annual fiscal budget requests. Course Work  The course must directly apply to the employee’s job description or for career redirection or advancement at ________________________ (Name of Employer) .  Scheduling/attendance of class time must not impede work duties and responsibilities or affect the performance of the individual or work team. The employee shall be held accountable for his/her regular workload and assignments. Refund Amount  Employer will reimburse employees for paid tuition for educational and vocational courses from an accredited university or college that directly apply to the employee’s job description, or for career redirection or advancement, at a limit of one class per term, up to three (3) terms per fiscal year, at the prevailing rate for a Graduate or Undergraduate course at __________________________________ (Name of College or University) .  Tuition will be paid at 100% upon receipt of fee statements and grades of “B” or better or “Pass” if the course is taken on pass/fail basis. If a grading system is not used for a course, the Director of Human Resources will determine if reimbursement is warranted.  Books and miscellaneous lab or activity fees are not covered under the Tuition Reimbursement Program.  All receipts and the official grade report or certification must be submitted with the request for reimbursement. The grade report or certification will be added to the employee’s personnel file.  Tuition will be paid at 100% upon receipt of fee statements and grades of “B” or better or “Pass” if the course is taken on pass/fail basis. If a grading system is not used for a course, the Director of Human Resources will determine if reimbursement is warranted.  Books and miscellaneous lab or activity fees are not covered under the Tuition Reimbursement Program.  All receipts and the official grade report or certification must be submitted with the request for reimbursement. The grade report or certification will be added to the employee’s personnel file. Employee Obligation  Employee must remain actively employed by _________________________ (Name of Employer) for a minimum of one year following the time of satisfactory course completion.  Employees who resign from ________________________ (Name of Employer) prior to the expiration of the required obligation period will reimburse the _______________________ (Name of Employer) for any tuition refunds received. _______________________ (Name of Employer) may recoup the funds through payroll deductions and/or through other such collection means _________________ (Name of Employer) elects to use. Procedure  Complete the top portion of the Tuition Reimbursement Application.  Obtain approval signatures from the Department Director, the Human Resources Director, and the District Administrator.  Upon approval by Department Director and the Human Resources Director you will receive a photocopy of the approved application.  Reimbursement requests must be submitted to the Director of Human Resources within 30 days of passing grade/certification.  Upon completion of the course, submit a copy of your approved application, with attached evidence of successful completion of the course, along with an itemized list of reimbursable expenses and receipts to Human Resources.  The Human Resources director will then complete the portion of the application titled “Human Resources Only” and will submit a check request to Finance.